Provider Demographics
NPI:1922394725
Name:BIRCHENOUGH, ERIN L (NP)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:L
Last Name:BIRCHENOUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22571 SUMMIT DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7233
Mailing Address - Country:US
Mailing Address - Phone:315-782-0136
Mailing Address - Fax:315-782-7212
Practice Address - Street 1:22571 SUMMIT DR
Practice Address - Street 2:SUITE B
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7233
Practice Address - Country:US
Practice Address - Phone:315-782-0136
Practice Address - Fax:315-782-7212
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33-336827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400082478Medicare PIN